Federal Fluoride Recommendation Lowered

For the first time since 1962, the federal government has changed its fluoridation recommendation. The U.S. Department of Health and Human Services (USHHS) and U.S. Public Health Service (USPHS) say in order to balance dental protection, while limiting the risk of dental fluorosis, the optimal fluoride concentration is 0.7 milligrams/liter (mg/L). Although USPHS recommends water fluoridation as an effective public health tool, the decision of whether or not to use fluoride is made by State and local governments.

In light of the new recommendation, the U.S. Environmental Protection Agency (USEPA) is in the process of determining whether it will change the maximum amount of fluoride allowed in drinking water under the Safe Drinking Water Act. Any changes to the standard could affect water systems that have naturally occurring fluoride. Currently, the USEPA's limit is set at 4.0 mg/L to protect against severe skeletal fluorosis, a bone disease that is caused by excessive fluoride ingestion over an extended period of time.

The new federal recommendation was developed by a panel of representatives from the USHSS, Centers for Disease Control (CDC), National Institutes of Health, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, Office of the Assistant Secretary for Health, USEPA, and U.S. Department of Agriculture. The panel used recent study results to review the fluoride standards that were established in 1962. The previous standards ranged from 0.7 to 1.2 mg/L and were based on the theory that residents of warmer climates drink more water; therefore, the fluoride concentration in those geographies could be lower than in colder areas.

It was determined that 0.7 mg/L is the optimal fluoride concentration based on the following points:

Community water fluoridation remains an effective public health strategy for delivering fluoride to prevent tooth decay and is the most feasible and cost-effective strategy for reaching entire communities.

In addition to drinking water, other sources of fluoride exposure including toothpaste, mouthwash, and professional fluoride treatments have contributed to the prevention of tooth decay and an increase in dental fluorosis prevalence.

Preventive benefits can be achieved and the risk of dental fluorosis reduced at 0.7 mg/L.

Recent data do not show a convincing relationship between water intake and outdoor air temperature. Thus, recommendations for water fluoride concentrations that differ based on outdoor temperature are unnecessary.

As an example, the required fluoride levels in Minnesota's public water supplies currently ranges between 0.9 and 1.5 parts per million (ppm), with 1.2 ppm considered the optimal level. In response to the updated fluoridation recommendation, the Minnesota Department of Health indicates it will develop a variance to the existing State standard that will allow water providers to lower their fluoridation level while the State's official standard is modified. After the variance is developed and communicated, formal rule writing will begin. The League of Minnesota Cities reports the process to change the rule may take more than a year to complete.

In North Dakota, fluoridation of public water systems is a voluntary program. The ND Drinking Water Program manages the voluntary implementation and provides fluoride level and sampling guidelines which must be followed for all participating systems. In 2011, in response to the USHHS and USEPA's proposed recommendation of 0.7 milligrams of fluoride per liter of water to replace the previous 1.2 milligrams, North Dakota provided the guideline for the optimal level of fluoride of 0.7 mg/L. An acceptable range of 0.6 to 1.7 mg/L of fluoride is allowed. The optimal fluoride level guideline for the State will be maintained at 0.7 mg/L in response to the newly released official recommendation.

If you would like to compare how much fluoride is included in your water system's H2O with other water systems, check out the CDC's "My Water's Fluoride" app. It breaks the information down by State, county, and individual water system.